In the year 2018, over 1 million people are living HIV positive in the United States. After the first detected case of HIV in the U.S., the FDA implemented a lifetime ban on MSM (men having sex with men) donating blood. Gay men have been barred from donating blood ever since.

Over 20 countries still impose a lifetime ban on blood donations from gay men, but in recent years, a variety of countries have begun alleviating restrictions and creating new processes to allow for donations without risking the spread of HIV-infected blood. Generally these procedures have taken the form of a deferral, in which the potential donor must wait a specified amount of time after their last sexual contact before they may donate blood.

In 2017, the UK officially lifted the indefinite ban on blood donations from men who have sex with men, instituting a three-month deferral process. New Zealand has also seen progression in the last ten years for allowing blood donation from gay men, going from a lifetime ban to a five-year deferral in 2009, then, in 2014, reducing the deferral to one year. Even the US relaxed its stance in 2015, from a lifetime ban to a one-year deferral.

However, these approaches still discriminate against men who are in long-term relationships and avoid engaging in behavior that puts them at risk. 2015 saw marriage equality become law throughout the United States, but even three years after that landmark decision, married gay men must abstain from sex with their husbands for a full year before they are eligible for blood donations.

This is an unacceptable situation for many involved in LGBTQ activism. In response to the UK’s switch in 2017 from a lifetime ban to a one-year deferral, Scott Cuthbertson of Scotland’s Equality Network told NBC News, “These new rules are a welcome and significant step forward. We remain concerned, however, that for too many low risk gay and bisexual men these new rules are, in effect, a continued ban.”

Many HIV/AIDS activists agree that pre-donation screenings should be done to test for the presence of disease, rather than sexuality. In the 1980s, methods of screening for HIV were not as sophisticated as they are currently. Often, the questionnaire that must be filled out before donating blood is a holdover from that earlier era, focusing on invasive questions designed to weed out sex workers and gay men. Today, it is clearer than ever that the sorts of behaviors these questionnaires ask about are not a fair evaluation of an individual’s eligibility to donate blood.

What’s more, there are much easier ways to test for the presence of HIV in potential donors’ bloodstreams today than there were in the late 80s. Today’s take-home HIV tests are 92% effective for determining if an individual is HIV positive or not.

So why is the United States so reluctant to lift the ban on gay men donating blood? The current government’s hostility towards the LGBTQ community is certainly one part of the problem; the Trump Administration has worked to impose legal cover for anti-LGBTQ discrimination in a variety of cabinet departments, from Justice and Education to Health and Human Services.

The availability of pre-exposure prophylaxis, or PrEP as it is more commonly known, is another. PrEP is a prescription drug that decreases the chances of HIV-negative individuals contracting the disease by as much as 90 percent. Although this allows HIV positive individuals to be able to engage intimately with people who do not have HIV, the cost of purchasing PrEP without any sort of financial assistance can be as much as $2,000. For most in this position, the cost is unrealistic, which needlessly increases risk.

But there is a deeper cultural problem as well. The United States approaches HIV/AIDS and other sexually transmitted diseases from a place of trepidation and uncertainty. Education plays a big role in whether or not people even learn about HIV, but as of 2016, only 24 states require that sexual education be provided to students during school hours. Even fewer states mandate any information of HIV/AIDS prevention be discussed. Meanwhile, a report by Guttmacher says that 37 out of 50 states require that information on abstinence be provided in sex education.

As a result of the overwhelming emphasis on abstinence in our culture, people are more likely to blame HIV-positive people for contracting the disease, rather than looking to health information services to help prevent future transmission. It is no surprise that a study done by the Centers for Disease Control found that, of the 1.2 million people estimated to be living with HIV in the U.S., 15 percent of these cases were undiagnosed. The Daily Beast’s Samantha Allen recently reported that 25 percent of young gay and bisexual men have never been tested for HIV in the first place.

The United States’ antiquated stance on sex is becoming deadly. The resources needed to keep individuals safe from sexually transmitted diseases and infections are either undisclosed or outrageously inconvenient. While home test kits are effective and fairly inexpensive, the cost of living with HIV after diagnosis is not.

The U.S. has had over 30 years since the first HIV-related death to revolutionize the prevention and treatment of HIV. As other countries make efforts to better understand and control the proliferation of HIV, it is time for the U.S. to revolutionize the way we view HIV-positive individuals.

Around the world, more countries than ever are allowing men who have sex with men to donate blood without a deferral, from Italy and Spain in Europe to Mexico and Peru in Latin America. We need to follow the positive example these countries have set and end the discrimination around the process of blood donation that has plagued the LGBTQ community for three decades and counting.

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